Deteriorating perception of HRMC a focus of interviews

The rift between Haywood Regional Medical Center administration and the medical community needs to be repaired, and public confidence in the hospital restored, Haywood County commissioners said last week.

Commissioners expressed these concerns while interviewing applicants for the hospital board. Haywood County commissioners will appoint three members to the hospital board next month. The public is following the appointment process more than usual.

The hospital board became embroiled in controversy late last year following a unanimous but unpopular decision to push out the hospital’s team of emergency room doctors called Haywood Emergency Physicians. A national physician staffing firm was hired instead, replacing long-time members of the medical community with a revolving door of pinch-hitters until new doctors could be recruited. The move was seen as a tipping point in a deteriorating relationship between hospital administration and the medical community, who increasingly felt pushed aside by decision-makers at the top.

The commissioners did not weigh in on the controversy at the time, but the types of questions posed by commissioners during interviews with hospital board applicants last week signaled concern among commissioners that the controversy has potentially hurt the hospital’s reputation. The hospital board interviews are considered a public meeting. Reporters from three newspapers sat in on the interviews.

Commissioner Skeeter Curtis cited a loss of confidence in the hospital among many citizens who were displeased with the decision to oust the old ER doctors. Curtis was the only commissioner who attended a public information meeting held by the ousted ER doctors last December to share their side of the story.

All three hospital board members who are up for re-appointment are re-applying for their seats. All three agreed the relationship between the hospital administration and medical community needs to be repaired.

When Commissioner Bill Upton asked Dr. Dick Steele about the biggest challenge facing the hospital board, Steele said the board needed to “work on the persona.”

“Recently I think there are just some bad feelings, so we need to work on that,” said Steele, a hospital board member re-applying for his seat.

Dr. Nancy Freeman, who is also re-applying for her seat, said the hospital board needs to “develop a better relationship with medical staff.”

Commissioner Kirk Kirkpatrick told Freeman during her interview that he would like to see the hospital board change the perception that doctors and the hospital administration don’t get along.

“We have some physicians that butt up against administration, that don’t particularly like administration and it’s been difficult to hammer that out,” Freeman said. Freeman cited strong egos as a culprit.

Jim Stevens, another hospital board member reapplying for his seat, also said the hospital needs to work on its perception with the public, but not just as a result of the ER controversy.

“We’ve go to make the perception that this is the place to go to, not to Sylva or Asheville,” Stevens said, citing Haywood Regional’s closest competition. “We’ve got to keep our people in Haywood County. That means good doctors and a good perception.”

He added that the hospital board needs to do a better job communicating with the medical community.

“That’s our biggest problem, and we haven’t done a good job with that,” Stevens said.

That rift seemed to be the only thing that all the applicants to the hospital board agreed on.

Dr. Luis Munoz, who is applying for a seat on the board, said physicians today do not feel like they have a voice in hospital affairs. Munoz said that hasn’t always the case.

“We all felt like we had a voice in the decisions that affected us,” Munoz said of year’s past. “Over the last three or four years, we have lost that. The collective message from the medical staff seems to carry less weight. I think we all need to work better to form a more cohesive partnership.”

Munoz said the “the circle of trust is broken.”

Dr. Henry Nathan, who is not currently on the board but hopes to be appointed, said the medical community is disturbed that the current hospital board has made several decisions in recent years that appear to have motives other than improving patient care — the move to oust the ER doctors being only one of those decisions.

“I am afraid the hospital board has taken a direction that is not in the best interest of the welfare of the hospital and its patients,” Nathan said. “I strongly believe the medical staff need to be more involved in speaking up for the benefit of our patients. When the medical staff do speak up, almost always the primary motivation is for the improvement of the highest quality patient care.”

The medical community spoke up in defense of the ER doctors last December, but the hospital board already had its mind made up.

Improving public relations

Commissioners asked several applicants what they would do to re-establish confidence in the hospital among both the public and medical community, but none had particularly concrete answers.

Freeman said the hospital is occasionally putting a full page in The Mountaineer to communicate good news about the hospital with the public.

Steele said the hospital board made an effort to share plans with the medical community about a new $15 million surgery center in the planning stages. Steele said the hospital board gave a presentation to the medical community about the plans so they would feel included. However, some hospital board applicants said the medical community is not pleased with the price tag on the surgery center, despite being privy to a presentation about it.

Gary Wooten, a hospital employee applying for a board seat, said the hospital needs to figure out what it wants to be.

“In the past we’ve tried to do this and tried to do that. We haven’t really defined what we want to be in the future,” Wooten said.

Nathan said the hospital board can repair damage over time by consistently showing that decisions are being made based on patient care first.

“We should stop to think before each and every decision, ‘Is this going to help patient care, facilitate patient care, improve patient care?’ If it is, then we should. If it doesn’t, then we shouldn’t,” Nathan said.

For example, the hospital administration has spent energy recruiting spine specialists for a spine center, but is woefully short in basic orthopedists, forcing patients with broken arms to go to hospitals in neighboring counties.

Dr. Mark Jaben, one of the ousted ER doctors who is applying for a seat on the hospital board, also said the hospital could improve its image by “redirecting its priorities.” Jaben expressed concern that hospital administration is short-shrifting patient care to serve other motives.

The ER controversy

None of the three members re-applying for their seat expressed second thoughts for their decision to replace the ER doctors.

“Do you have any second thoughts? Do you see anything to lead you to believe that maybe it wasn’t the right decision,” Curtis asked Freeman during her interview.

Freeman called the situation “unfortunate,” but said the hospital board had been left no other choice. Haywood Emergency Physicians would not accept new language in its contract. (The contract was not up until spring 2008, but the hospital wanted to changed the language in the doctors’ contract. The ER doctors objected to language that would give hospital administration control over the doctors.)

Freeman said the ER doctors were unwilling even to compromise.

“We got not one concession,” Freeman said.

Steele stood behind the decision as well.

“I know I pissed off a lot of physicians and some people in the community, but I thought it was the best move. I have not heard any flack yet on what is taking place down in the ER,” Steele said.

“It eroded confidence a lot in the community with the hospital,” Curtis countered.

“We do need to work on the persona,” Steele answered.

Wooten was the only applicant not currently on the board who said he supported the move to oust the ER doctors.

“I agree with what the board did. There weren’t no other options,” Wooten said. Wooten blamed the ER doctors for being obstinate.

“Haywood Emergency Physicians should have responded earlier. If that conversation had taken place, it never would have reached the explosive situation,” Wooten said. “The physicians do not run the hospital.”

When Commissioner Mary Ann Enloe asked Stevens, a sitting board member re-applying for his seat, whether the ER change was working out, Stevens said he couldn’t tell.

“It’s hard to know, to be honest with you, if it is truly working well,” Stevens said. “Everybody says it’s working well, but I haven’t been down there and I haven’t talked to anybody except the people who say it’s working well.”

The county commissioners will likely make their decisions about who to appoint to the hospital board at their meeting on May 7.

The county commissioners have ultimate control over the hospital board, which in turn has the final say in hospital affairs, including hiring and firing authority of the hospital CEO. The hospital board currently has eight members, all appointed by the county commissioners. The county commissioners could increase the number of hospital board members any time to as many as 21. If the commissioners disapproved of the hospital’s direction strongly enough, they could appoint nine new members to the hospital board to outvote the existing eight board members.